acute mesenteric lymphadenitis
Introduction
Introduction to acute mesenteric lymphadenitis Acute mesenteric lymphadenitis, also known as acute non-specific mesenteric lymphadenitis (acutenonspecificmesentericlymphadenitis), was first proposed by Brenneman (1921), common in children and adolescents, with fever, acute abdominal pain as its clinical features, general case drug treatment is effective, a small number of mesenteric lymphadenitis Suppuration after suppuration requires surgical treatment. basic knowledge The proportion of sickness: 0.0023% Susceptible people: no special people Mode of infection: non-infectious Complications: abdominal pain, intestinal obstruction, abscess, peritonitis, bloating
Cause
Causes of acute mesenteric lymphadenitis
Toxic effects of viruses and toxins (35%)
Coxsackie B virus (Coxsackie B virus) Clinical data have confirmed that the main cause of mesenteric lymphadenitis is Coxsackie B virus and its toxins, the virus and its products through the blood circulation to the mesenteric cause acute inflammation of the lymph nodes.
Bacterial infection (25%)
Streptococcus and Staphylococcus aureus are also important factors in causing this disease. These pyogenic bacteria and their products cause acute infection of mesenteric lymph nodes from the primary lesion through the blood or lymphatic route, and the inflammation is usually severe.
Parasite (3%)
Bacterial and parasites in the intestine such as Salmonella, Yersinia, Schistosomiasis, Amoeba, etc., can directly invade the mesenteric lymph nodes through the intestinal wall, causing specific inflammation, but it is rarely seen clinically.
Pathological features:
In the early stage of inflammation, the mesenteric lymph nodes are swollen, dark red, non-adhesive to each other, soft to the touch, can move, the lymph nodes gradually become harder, grayish white appearance, and a small amount of serous exudate in the abdominal cavity, under the microscope The main findings are lymphoid hyperplasia, hyperemia and edema. In a few cases, lymph nodes show suppurative changes, which can form abscesses and even fuse into larger abscesses. After ulceration, they lead to suppurative peritonitis, which is affected by mesenteric inflammation and the end of the ileum. The cecum and appendix can be accompanied by different degrees of inflammation. Under normal circumstances, abdominal exudate and enlarged lymph node puncture are mostly negative for bacterial culture.
Prevention
Acute mesenteric lymphadenitis prevention
Mesenteric lymphadenitis is mostly a viral infection, often complicated by acute upper respiratory tract infection, or secondary to intestinal inflammation, so usually pay attention to prevent colds and fever and pay attention to diet.
Complication
Acute mesenteric lymphadenitis complications Complications abdominal pain intestinal obstruction abscess peritonitis bloating
Occasional suppurative mesenteric lymphadenitis, its onset of sudden onset, sudden abdominal pain, chills and fever, abdominal pain is mostly persistent with paroxysmal aggravation, when the inflammation affects the intestine, it can cause intestinal paralysis and intestinal obstruction symptoms, once the abscess collapses Causes peritonitis, abdominal pain and bloating are intensified, systemic poisoning symptoms are obvious, often peripheral blood neutrophils with nuclear left shift.
Symptom
Acute mesenteric lymphadenitis symptoms Common symptoms Nausea abdominal pain Sore throat Right lower abdominal pain Lower abdominal rebound Bleeding Umbilical pain Painful pharyngeal congestion
1. Upper respiratory tract infection: The patient has symptoms of upper respiratory tract infection such as hypothermia, sore throat and cough in the near future, or a period of sensation during medical treatment. It is characterized by abdominal pain accompanied by fever, headache and pharyngeal congestion (about 42.5). %).
2. Superficial lymph node enlargement: The superficial lymph nodes of the neck may be reactive, and the palpation may be accompanied by swelling of the lymph nodes with tenderness. After the recovery, the swollen lymph nodes can return to normal.
3. Abdominal symptoms and signs: Abdominal pain is the main reason for patients to seek medical care.
(1) abdominal pain occurs more urgently, often characterized by colic and paroxysmal, intermittent abdominal pain is obviously improved, or no discomfort, as usual, abdominal pain is often more extensive, pain can start in the upper abdomen, umbilical or The whole abdomen is later confined to the lower right abdomen, often accompanied by mild gastrointestinal reactions such as nausea, vomiting, loss of appetite and diarrhea.
(2) Abdominal tenderness is mainly in the right lower abdomen, but the range is wider, and the tenderness is obvious. The change is not constant. When the left lateral position, the tender point can also move to the left side, and the abdominal muscles are less or less. The rebound pain is often negative, and some patients may have nodular masses with tenderness in the right lower quadrant, most likely a swollen mesenteric lymph node.
Examine
Examination of acute mesenteric lymphadenitis
1. Blood routine: peripheral blood leukocyte count often does not increase or decrease, lymphocyte ratio is relatively high, if suppurative mesenteric lymphadenitis with obvious systemic poisoning symptoms, often peripheral blood neutrophilia with nuclear left shift .
2. Lymph node biopsy: When exploratory laparotomy, lymph node biopsy can be performed at the same time as the appendix is removed.
3. Bacteriology examination: Take the broth culture and drug sensitivity test.
4. B-ultrasound: the sound image shows: the ileal wall of the ileum is thickened, the lymph nodes are swollen, and no appendix is seen.
5. CT scan: It can be seen that the appendix is normal and the lymph nodes are swollen.
6. Diagnostic puncture of the abdominal cavity has a certain significance for differential diagnosis.
Diagnosis
Diagnosis and diagnosis of acute mesenteric lymphadenitis
Diagnostic criteria
There are three diagnostic criteria for acute non-specific mesenteric lymphadenitis:
1. Adolescents or children have acute pain in the lower right abdomen after an upper respiratory tract infection.
2. The onset of abdominal pain is more urgent, but there may be no discomfort during the intermittent period, as usual.
3. The right lower quadrant is not fixed, the range is large, and sometimes the swollen lymph nodes can be touched.
Differential diagnosis
1. Acute appendicitis or abscess around the appendix: mesenteric lymphadenitis is the most likely to be misdiagnosed as acute appendicitis. The tenderness of this disease is slightly higher than the tenderness point of appendicitis, and the medial side, the tender point is not fixed, and there is little rebound tenderness and abdominal muscle tension. The persistent right lower abdominal pain and the persistent fixation of the right lower abdomen are characteristic of appendicitis.
2. Primary peritonitis: also more common in children, but more girls, abdominal pain is heavier, a wider range, the lower abdominal peritoneal stimulation is also more obvious, abdominal diagnostic puncture can extract thin purulent secretion, smear Microscopic examination revealed a large number of Gram-positive cocci.
3. Mesenteric lymph node tuberculosis: more secondary to tuberculosis, intestinal tuberculosis, longer course, accompanied by obvious symptoms of tuberculosis, abdominal pain is not severe, the site is not clear, abdominal signs are lighter.
